Every nurse I spoke with at the recent Maine State Nurses Association convention said “all of us probably have MRSA colonization”. One nurse in particular was very upset at the prospect of ever being screened for MRSA, because of her constant exposure to it and because if she turned up positive, it might cost her the job that she needs to support her family.

I was surprised that only 4% of healthcare workers, both direct caregivers and remote workers were infected. That is much lower than I expected. But, at the same time it is encouraging. My concern is what recommendation comes from this fact.

As a potential Healthcare consumer , I would not want a nurse who is actively colonized with MRSA caring for me, or for a vulnerable loved one……not unless a special precautions are taken. Were the HC workers who tested positive in this study decolonized or not? The article does not tell it all. Even if they were decolonized, we know that MRSA is transient and many of these employees may turn up positive again 3 months after decolonization. Maybe more than Standard and Universal precautions are necessary when a HC worker is colonized with MRSA. Education is paramount. The colonized HCW should be educated about not only using meticulous Standard and Universal precautions, but also using reverse precautions at all times. They should be told not to work when they are actively infected with a respiratory illness, especially while actively coughing, sneezing and blowing their nose. MRSA can be coughed about 4 feet into the environment. Also, a known colonized HC worker should always wear a mask while doing invasive sterile procedures, like dressing changes and catheterizations. So, is the answer to this dilemma to use decolonization and education about extra precautions? I don’t really know, but I do know SOMETHING definitive needs to be done and the things I have suggested here would be a start.

Now as a nurse, I have to wonder if my job is jeopardized if I am diagnosed. Is it? If my employer finds that I am colonized, will it affect my job. Will I be put out of work? Will it affect job promotions or transfers into other departments? These are legitimate and serious concerns. MRSA now becomes not only a threat to my health, but it is also a threat to my livelihood! As a member of MSNA and the NNU and a long time supporter of Nurses Unions, I am proud to say that nurses represented by a union will have some protections in place regarding employment. My friend, who I have written about a few months ago on my webpage, is a non represented nurse and since her MRSA pneumonia and sepsis, followed by a lengthy recovery and lingering disability, she has been unable to find work as an ICU nurse. She feels that the places who will not hire her discriminate because they know her MRSA status. Another nurse I know tested positive in an investigation for an outbreak in her hospital. Her employment was not affected, but the records of her MRSA colonization and her decolonization treatment for it were buried………..she was told there was no record of it. Healthcare facilities get the right to ignore the elephant in the room regarding the risk of infectious disease to employees. They get to decide on policy that is either good and effective or lax and ineffective. Unfortunately, very few come to the plate with the safety of their nurses in mind.

I see many problems at many levels with all of the above. Nobody is recognizing the fact that Healthcare workers in hospitals become colonized with MRSA. The problem is not acknowledged or addressed. If someone is discovered to be colonized, the records are “unavailable”. This may be because of fear on the part of the hospitals. They fear liability for their employees, because they have become colonized (and sometimes actively infected) on the job. And they fear liability from patients who become infected while hospitalized. So, the usual reaction to that fear is to keep it all a secret??? News alert…these problems are not going away unless the hospitals get on board with prevention. These problems, if left unsolved feed on each other! We cannot fix what we do not acknowledge and measure.

I believe MRSA needs to be put out there, as an issue and a problem within healthcare facilities, for both patients and employees. Preventing spread of MRSA by screening and Isolating patients is the first step to “getting to ZERO” with MRSA infections. Addressing employees concerns by recognizing MRSA as a work related infection and doing appropriate and timely testing, treatment and education for it is the best approach.

Trying to hide/bury the problem, or ignoring the huge population of patients who come in the door colonized, who subsequently become infected is no longer acceptable. Too many times, it takes days or weeks to diagnose an active MRSA infection in a patient. Most of the time, the causative problem, MRSA colonization, is never even detected because there has been no screening. By the time active infection is diagnosed dozens of HC workers and family members are all exposed. Active Detection and Isolation (ADI) will prevent this from happening.

Early detection of colonization or infection, isolation of affected patients, decolonization when appropriate and education are all necessary steps toward stopping MRSA.

NO NURSE should feel that their job is jeopardized by MRSA colonization. It is job related and should be addressed as such. And NO PATIENT should have the worry that proper MRSA detection and prevention of MRSA is not being used in their hospitals or that their HC giver may spread MRSA to them.

Last edit by Joe V on May 10, '10
: Reason: formatting for easier reading

My understanding, from an infectious disease specialist and the literature I have read, is that you can never reliably decolonize someone.

I had sepsis from MRSA in 2004 and will always be considered colonized.

May 11, '10

You can decolonized someone and some stay decolonized, some don't. To say it can never happen is not accurate. Some will be recolonized after just 3 months. MRSA is transient, but it can be irradicated by following a strict protocol. Admittedly, it doesn't work for everyone.
The people that decolonization matters most to are people who are undergoing invasive procedures. Decolonization, even if it is temporary results, will decrease their likelihood of an active infection 7 times over. Also, if they are having surgery, the appropriate pre op antibiotics can be administered.
You might or you might not be colonized. If I was you, I would request a screening if I was readmitted to the hospital. It is always valuable information to know if you are colonized. Many hospitals do have a policy of "once colonized, always colonized" and I honestly believe that is just the easy way out...no screening culture needed. But, they will isolate you in most cases.

May 11, '10

You misread -- I said never reliably decolonize.

May 11, '10

I guess I did misread your quote.
I still feel that decolonization is always worthwhile to attempt when the results may be helpful in prevention of an active infection. I had this argument with an epidemiologist when I fought for MRSA screening in Maine, and it seemed that this treatment, for prevention purposes is rationed and only used for certain patients.
Every patient deserves to be as protected as possible from an active MRSA infection.
And, for your personal purposes, it is important to remember that not all MRSA is equal. You may be colonized or not and your MRSA may be the same one as you had before or may be a new strain. It is always important to know your status, particularly if you are facing an invasive procedure, or if you are discovered in an investigation of an outbreak. Those two situations (at the least) are important times to be decolonized.
MRSA is transient, tough and persistant, but active infections can be prevented with the correct steps.

May 14, '10

Mammy1111 -

Thanks for posting the article. I was surprised to see how low the colonization rate was for healthcare workers (~4%).

May 15, '10

Over-treating colonized/not active infections will just make MRSA even more antibiotic resistant. It's the same as giving antibiotics to someone with the flu "just in case."

I took care of a patient for 4 days, and on the 4th day, the IC nurse calls and says he has to be on contact precautions because 5 years ago, he had MRSA in his gtube site, and he will forever have to be on contact precautions unless he gets the gtube out. I'm really starting to feel like MRSA, unless it's oozing, should just be treated like any other infection. It's not the gowning up that's protecting other patients, it's the washing my hands after I'm in the room. Unless the patient is dripping MRSA wound juices, the MRSA isn't flying around the room, attaching to whatever it can find. I'm really thinking that putting everyone on precautions just makes us more likely to take it less seriously for a patient that REALLY should be on precautions.

May 16, '10

It is scientific fact that colonized MRSA can spread. It is also scientific fact that a patient is 7 time more likely to develop an active MRSA infection if they are not decolonized. I am not suggesting that every single colonized person be decolonized...only the ones who are facing an invasive procedure, and nurses who are discovered colonized in an outbreak investigation.

A colonized patient can and does spread MRSA into his environment, so it is not only your hands that pick up the microbe, it is also your uniform and any medical devices used. If the patient is coughing, he/she can spew it up to 4 feet into the air.

So, contact precautions including handwashing, gloves, gown, (mask if actively coughing or doing a procedure that induces coughing) are all necessary to stop the spread of MRSA. If there will be no direct contact with the patient and or his environment...ie. passing him a pill...there would be no need for the gown.

Without actively detecting MRSA, Isolation and contact precautions, decolonization when necessary, education, and adequate room decontamination, the MRSA epidemic will continue to grow and spread. It is a crime, since we know that ADI works. Take a look at the VA program and the results of it.

May 16, '10

I am kind of shocked the percentage of healthcare workers colonized is not higher. However, I know that if I ever get admitted to the hospital I am refusing MRSA swabbing. Unless I am a patient in the ICU and actively dying, I do not want to know if I am colonized with MRSA or not.

May 16, '10

While I do understand your feelings about not being swabbed, I feel that it is unwise. If you are colonized, you are at much higher risk (at least 7 times more likely) of active infection. The things that doctors do differently if you are MRSA colonized are 1. decolonize prior to risky procedures thereby decreasing your chances of active infection, 2. give appropriate antibiotics preoperatively instead of something that will encourage growth and antibiotic resistance of your MRSA colonization, and 3. separate you from other patients to avoid spread of desease. So, swabbing is and a tremendously valuable test for both you and the patients around you. Fear or swabbing is unwarranted and puts you and those around you at greater risk...if it leads you to refuse swabbing. I, for one, will ask for swabbing if I am admitted to the hospital. I have witnessed the death of my father because a hospital did not initiate screening after a known outbreak and 2 other previous deaths. Now after over a year of MRSA advocacy and activism, I have spoken with and met hundreds of victims of MRSA. I will do all I can to avoid an active infection including MRSA screening....for myself and anybody else that I care for.
I will continue to work with legislators and others to mandate that at the least, high risk patients be tested on admission, or just prior to admission to hospitals. I am 100% convinced that ADI (Active Detection and Isolation)saves lives. It is proven over and over....check out the VA hospitals MRSA program.

May 16, '10

"It is also scientific fact that a patient is 7 time more likely to develop an active MRSA infection if they are not decolonized."

H again,

Can I get details on the research that supports this (see quote above).

Thank you

May 16, '10

I will get that to you as soon as i find it in my research articles....this afternoon sometime.